A New Clinical Pathway for Identifying Non-Responders to Glaucoma Eye Drops
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND/AIMS
Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops.
METHODS
A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways.
RESULTS
Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation.
CONCLUSIONS
The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption.
TRIAL REGISTRATION NUMBER
ISRCTNID:ISRCTN75888393.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Disclosure statements are available on the authors' profiles:
Acceptability, Adherence and Economic Analyses of a New Clinical Pathway for the Identification of Non-Responders to Glaucoma Eye Drops: A Prospective Observational Study
Br J Ophthalmol 2020 Mar 04;[EPub Ahead of Print], H Waterman, S Read, JE Morgan, D Gillespie, C Nollett, D Allen, M Weiss, P AndersonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors report an observational study on 50 patients who completed all procedures in the study in order to, "...assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non- responsiveness and non- adherence to the treatment of elevated intraocular pressure with latanoprost eye drops."
The bottom line is that, "The non-response rate was 5.1% and patients instilled eye drops as per their prescription on 73% of observed days." I suspect most clinicians would not opt for the schedule disruption necessitated by the Cardiff Model of Glaucoma Care (CMGC) protocol proposed by the authors.
This is a nice public health study based on the Cardiff Model of Glaucoma Care (CMGC), and its revision based on input from clinicians. The revised CMGC seems to improve acceptability and adherence, yet it is somewhat discouraging that, even with the revision, patients instilled drops as per their prescription instructions at only a 73% rate of compliance on observed days. So, even under conditions of scrutiny, adherence remains an issue. Particularly when the drops are not successful in lowering IOP, clinicians need to balance the complex interrelationship among efficacy, economics, and adherence in real-time adjustments of medications and visit intervals.